Posted
by
CmdrTaco
on Thursday June 04, 2009 @09:17AM
from the oh-that's-not-good dept.

CurtMonash writes "The Indianapolis Star reports that Tuesday Morning, Methodist Hospital turned away patients in ambulances, for the first time in its 100-plus history. Why? Because the electronic health records (EHR) system had gone down the prior afternoon — due to a power surge — and the backlog of paperwork was no longer tolerable.
If you think about that story, it has a couple of disturbing aspects. Clearly the investment in or design of high availability, surge protection, etc. were sadly lacking. But even leaving that aside — why do problems with paperwork make it necessary to turn away patients?
Maybe the latter is OK, since there obviously were other, more smoothly running hospitals to send the patient to. Still, the whole story should be held up as a cautionary tale for hospitals and IT suppliers everywhere."

The hospital I work for is implimenting a form cycle that allows forms to be printed and scaned back to the EMR. Such a system woudl allow my hospital to use the old paper system but maintain the records electronicly if there was ever a temporary interuption of the EMR.

If you find an old, pre-1950 dictionary and look up "computer", you'll find that it defines "computer" as a person who is employed to do maths. Thousands of computers were employed for the military, large corporations, etc doing ballistics calculations, statistical math, and the like.

There are fewer and fewer human secrtaries, as human secretaries are going the way of the human computer. Electronic computers are superceeding human secretaries just as they obsoleted human computers.

Funny aside. I happen to know a few physicians pretty well outside their professions. I heard a lovely story involving a surgeon in an office that didn't use paper records. Everything was done through an EMR system.

The "computers were down" as the story was relayed. The surgeon called the family physician asking him about the medical history of the patient. The family doc (primary) asked what was wrong. The surgeon replied that the patient was in the waiting room, but since the EMR system was down, he didn't know anything about the patient. The primary responded with, "By any chance... Did you ask them?" to which the surgeon responded, "What?" The surgeon had a perfectly compus mentus patient, and didn't even bother to ask them a question because the EMR system was down.

Sometimes the lawyers don't even have to be involved for epic failure.

Patient safety is another one. If you can't keep up with the paperwork then the next doctor that sees the patient has no idea what drugs were given, etc. Without all the facts available, diagnosis and treatment go out the window.

No, in the modern US medical system, the paperwork amounts to tons of paper. The manpower needed to maintain it; file new info, pull deceased patients is huge, for a large hospital, the space requirements are huge. The possibility of error (misfiling info, patients with similar name, married name changes, etc)is huge.
From a legal point of view, you are probably more safe shutting the place down because EMR is down rather than trying to deal with a backup paper system.
It's not best for the patients, but the medical/legal/government system has cared increasingly little about the individual human being for a while now. I say this as an employed experienced MD.

Years ago, probably in the early 1980's, a friend of the family had to be checked into a hospital. She was on dialisys (kidney disease) and obese and had other troubles associated with the combination of those two conditions. Things went wrong for her pretty frequently.

The hospital food cart kept bringer her food that would flat out kill her: no kidneys means no ability to deal with floods of certain chemicals -- potassium, for example. She used to joke about committing "bananacide". She could just eat a few bananas and sit down to wait for the inevitable.

Day after day, meal after meal, the food cart would bring her food she couldn't eat. She was going hungry when she was sick. She would plead with the staff, but they didn't change anything.

My father went to visit her and she begged him to help her. She was getting weaker every day. He talked to the staff and pursued the problem until he got to one of the people actually choosing the meals.

The nutritionists were doing the right thing. They were picking the right foods for someone who was obese and had other problems. They were NOT considering the fact that her kidneys didn't work. Why? Because the screen they saw only had room for a few conditions. The last one on the list -- Kidney failure -- wasn't showing. There were a fixed number of lines.

Someone had to shuffle the order of the values so that the various nutritionists, with their hundreds of patients a day, could keep track of what to feed her from then on.

She died a few days later.

Was it because she'd been underfed for days? Would feeding her have helped? I don't know.

But the story illustrates how a reasonable assumption made by someone in the chain that you'd need, let's say "four" lines in that field there, could kill someone.

Surge suppression seems like a no brainer, but the people making the decisions are not always the people who should be.

But someone could die if they're too anal about it. I say stick to safe procedures, and let the hospital eat a loss while the system is down. When a toll plaza is down, they let people cross it for free, they don't block the highway.

One of the things that drove the revolution in understanding of Koine Greek (as used in the New Testament) over the last 200 years or so was the discovery of a massive cache of routine commercial transactions in Egypt, written on Papyrus. So, your $15.19 @ Lulu.com might be more relevant than you realize.

Your statement about Methodists' incompetent management is valid. Every three year's or so they've had some terrible [google.com] safety [google.com] failures. Quality care is just not a priority for them.

This is not so much a story about electronic records as much as it is about Methodist keeping up it's infamous safety record.

Really? My first thought was about the insurance companies and billing. Then I read the article (silly me!) and have come to the shaky conclusion (there's not much info in the article) that it's really just a matter of not having enough staff to manually write things down when the database goes down. Something everyone here should at least peripherally understand.

Sorry to step on your rant. BTW, how could you come to the conclusion that it's just the government and not the insurers that want access to patient data? You weren't just trolling were you?

Same thing happened, but it didn't shut down the Hospital(s).
Data ceter they have in Addison, that is WAY to big for the power and data lines they have, blew a breaker.
Not just ANY breaker, but the 800amp main breaker that comes in. The backup was fine, but this baby not only blew itself in a nice fiery mess, it took the UPS with it, requiring all the electronic guts to be removed. Thing was that they had on UPS and two power circuits. So when even that one blew, the UPS shut down and EVERYTHING shut down. Billing, CAT scans SAN's and all of the intranet and internet.
God, I was one of the vendors, but I could see people burning money in there. Cisco eng was there, IBM, Sun, HP, Dell. EVEY vendor for all their software. They had many EMC techs there. All of us were standing around, a good 15 feet away mind you, as the UPS guys were rebuilding the damn thing.
Was there for 8 hours of over time. Luckly this was all at night, but really, who the heck do you blame for a faulty main?

"Unless it's acid-free paper, a book will last maybe fifty years before it starts deteriorating. I have old paperback books I bought when I was young that are nearly unreadable now. Paper is far more nebulous than electronics."

Your old paperbacks are not good examples, as they were =intended= to have short-term durability and be more or less disposable -- similar to today's CDRs. A better comparison from a backup standpoint would be good quality hardbacks.

Here's a 5.25" floppy. It's less than 15 years old. I'd warrant not 1% of the people reading this post have the equipment required to read this once-common format -- assuming, of course, that the data on the disk is still readable, which is highly doubtful.

Conversely, I have here a book published in 1848. It's still perfectly readable to anyone with eyes, no other equipment required.

The problem really is how often one must upgrade the storage media, and how durable it is in the face of failure. Books can burn, but meanwhile they can be copied by anyone with pen and ink. Digital media requires matching hardware just to read it, another set of hardware to print it out, and rigidly regular backups to newer media forms as old ones age out and ultimately become unavailable.

I work as IT support in the health care industry, for what it's worth.

Most of our nurses are competent, dedicated people who are very good at their jobs: caring for patients, following medical orders, and keeping records about visits. They are awesome people.

They are not, however, able to use a computer by and large. And that's a real shame, because the computer is one of the most vital and prevalent tools that they are called upon to use every day. They've just built their skills up elsewhere, and computer literacy is still working its way into the medical curriculum, albeit slowly.

While our nurses spend years getting trained to do medical work, they get almost no acclimation to using the kinds of record keeping applications they're required to use in the field. It's a damn shame. They know just enough to turn the thing on and push exactly the indicated buttons in exactly the indicated order to. Anything outside those parameters means driving off the edge of the map and into a terrifying, unknown world.

All this is to say: I'm willing to bet that most of the nurses in that room had no trouble at all when the computers went down. It meant going back to paper notes for their patient visits, which a lot of them may actually prefer. Their biggest problem was probably finding the right forms, or running out of sheets of paper to use in the meantime.

The data entry folks, of course, probably had multiple heart attacks all day long. At least they were near the emergency room... if only they could be admitted.

Kinda like how stewardesses are now called flight attendants, even though historically a steward was in no way a menial job. Stewards were probably one of the highest, if not the highest, ranking non-nobles in the household.

My grandmother recently had her gallbladder removed and amusingly enough, the only 'electronic records' issues she had were the nurses who refused to provide things like IV's when they couldn't figure out how to scan the bar code off the bag so it could be tracked (and charged). They held up getting her one by about thirty minutes as they dithered around trying to pull their heads out of their asses and manually entered it into the system.

I absolutely guarantee you that a good portion of the 'paperwork overflow' weren't actual patient care records and were actually inventory control issues where the hospital was worried that an aspirin here or there might go unbilled.

Doctors and nurses know how to operate without electronic records. They know how to keep paper charts, while EHR's have the potential to make them more efficient but they aren't required for the job. Accounting, especially as detailed and 'cost controlled' as a hospital's, is a different story.